Abstract and Introduction
Abstract
The growing focus on providing high-quality care suggests that nurses' involvement in quality activities is likely to increase in coming years. By actively participating in the improvement of health care, nurses benefit their patients and stimulate joy in work.
Introduction
Most health care providers begin their health profession education expecting to acquire the knowledge and skills needed to provide high-quality care. However, as they advance through their education and begin their careers, they discover that health care systems are exceedingly complex, with a myriad of system issues that often make the provision of high-quality care difficult.
Over the past several years, many reports have outlined the problems in quality that plague the health care delivery system. Chassin and Galvin (1998) identified pervasive underuse, overuse, and misuse of health care resources as a quality problem. Investigations of adverse drug events (Bates et al., 1995; Leape et al., 1995) revealed surprising frequencies of medication-related harm, and studies exploring the risk of injury from medical errors challenged long-held beliefs that health care systems worked only for the good of patients (Brennan et al., 1991; Leape et al., 1991). The Institute of Medicine (2001) defined aims for improving the functions of the health care system, stating that care should be safe, effective, patient-centered, timely, efficient, and equitable. However, even a cursory examination of much of the care received by the majority of patients reveals that these aims are often not realized. Health care errors continue to occur at alarming rates, with approximately 3% to 4% of hospitalized patients suffering a serious adverse event (Thomas et al., 2000) and as many as 1 in 200 hospitalized patients dying of a preventable adverse event (Baker et al., 2004).
The time required for best evidence to be integrated into clinical care may be improving, but remains far longer than the ideal (Lee, 2007). Accounts of personal experiences written by recent recipients of health care are replete with reminders that health care systems are often not truly patient-centered (Cleary, 2003). Delays in achieving needed care cause frustration and at times compromise outcomes (Murray, 2002). Per capita health care expenditures in the U.S. remain higher than those of any other industrialized nation; yet, over 45 million individuals in the U.S. lack even basic health insurance (Porter & Teisberg, 2006). These data attest to the reality that the current care system does not consistently deliver care that is safe, effective, patient-centered, timely, efficient, or equitable. The Institute of Medicine (2001, p.1) defined this failure in care delivery as "not a gap, but a chasm." This article will define quality as a core competency for health professionals and provide a description of how nurses are contributing to quality improvement.